title: N-terminal pro-brain natriuretic peptide as a useful predictor of early surgery in neonates with congenital heart diseases: a prospective observational study.
abstract: Pediatric studies have found a correlation between the clinical heart failure score and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels. However, the clinical usefulness of this marker remains unclear in neonates. At hospitals without pediatric cardiologists, neonatologists or general pediatricians must judge whether surgery is indicated and transfer patients to a specialized hospital in a timely fashion as required. Thus, we tested the hypothesis that increased NT-proBNP levels predict short-term outcomes in neonates with congenital heart diseases (CHDs) and are thus a useful tool for evaluating clinical status and guiding treatment. Subjects were term or near-term newborns (≥36 weeks' gestation) with CHDs confined to left-to-right shunt lesions. Clinical parameters and NT-proBNP levels were measured on the first 7, 14, 21, and 28 days of life (DOL). We divided patients into a surgical (n = 7) and a conservative-treatment group (n = 21), and then compared clinical variables and outcomes between the groups. In the surgical group, NT-proBNP levels had a tendency to increase during the first 14 postnatal days and were significantly greater than in the conservative-treatment group on 7 DOL [median (range), 13,983 pg/mL (4,732-26,524) vs. 1,954 pg/mL (671-10,881); p = 0.0028] and on 14 DOL [29,274 pg/mL (14,006-33,740) vs. 2,050 pg/mL (1,304-9,250); p = 0.0055]. In contrast, NT-proBNP levels tended to decrease sequentially in the conservative-treatment group. The values of additional markers, such as mean NT-proBNP level on 7 and 14 DOLs (M7-14) and NT-proBNP level on 14 DOL minus that on 7 DOL (Δ7-14), were both significantly greater in the surgical group than in the conservative-treatment group. To examine the usability of M7-14 and Δ7-14 when the difference and mean cut-off levels were set at 10,000 and 3,000 pg/mL, respectively, the sensitivity and specificity were both 100 %. In neonates who had CHDs with left-to-right shunt, analysis of the association between clinical variables and short-term outcomes showed that NT-proBNP, especially M7-14 and Δ7-14, is a useful predictor of early surgery.
authors.affiliation: Department of Pediatrics, Beppu Medical Center, National Hospital Organization, 1473 Oaza-Uchikamado, Beppu City, Oita, 874-0011, Japan, mikamakimura@beppu2.hosp.go.jp.
authors.forename: Mika
authors.initials: M
authors.lastname: Makimura
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Koga
mesh_terms: D015415:Biomarkers / Q000097:blood; D006328:Cardiac Catheterization; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D061827:Dimensional Measurement Accuracy; D004374:Ductus Arteriosus, Patent / Q000097:blood / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D004452:Echocardiography; D005260:Female; D006343:Heart Septal Defects / Q000097:blood / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D007231:Infant, Newborn; D007564:Japan; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D017063:Outcome Assessment, Health Care; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013223:Statistics as Topic; D047929:Term Birth; D061665:Time-to-Treatment
chemical_list: D015415:Biomarkers; D002317:Cardiovascular Agents; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain